Patna: Decline in number of patients visiting government hospitals

Patna: The year 2016 has brought a shocker for the state on the healthcare front. CM Nitish Kumar had repeatedly said that the number of patients going to government hospitals has steadily increased during his regime, but the status presented in the state's Economic Survey 2015-16 shows a reversal of the trend. So is the case of institutional delivery in the state, which showed decline after constant increase in last several years.

The survey states that the monthly average number of patients visiting government hospitals declined by 5.8% in 2014, the last year for which the stats have been presented. From 2011 to 2013, the figure showed a constant rise. Experts attribute it primarily to non-availability of drugs in government facilities.

Besides drugs, the patients also have to incur huge costs on pathological services, a point underlined by the CAG report for 2014-15. "Pathology (facility) was available in 54% referral hospitals (RHs) and 31% primary health centres (PHCs). Thus, health care units in the state did not have the required diagnostic facilities," the report says. Similarly, sonography facility was available in 14% referral hospitals and nine per cent PHCs.

Dr Shakeel, the Bihar representative of People's Health Movement, said "When patient has to spend so much out of his pocket on drugs and diagnostics, he finds no point in visiting government hospitals."

So far as institutional delivery is concerned, the survey shows that for the first time in eight years, it declined by 6.1 per cent in 2014-15, after going up from 2006 to 2014. While the economic survey is silent about the reasons, experts say one could be non-disbursal of claims under Janani Suraksha Yojana (JSY). Under the scheme, all pregnant women who deliver in health centres are eligible for a cash incentive of Rs 1400 and Rs 1,000 in rural and urban areas, respectively.

The CAG report presented this year also substantiates the claim. It says payment was made to only 66% beneficiaries of institutional delivery. "It was also observed that payments to 6,027 beneficiaries of JSY amounting to Rs 82.35 lakh pertaining to 27 test-checked RHs/PHCs was entered in cash book but the cheques remained undelivered to beneficiaries as on date of audit (June-July 2015)."

Dr Shakeel says lack of ambulance services to carry women in labour to hospitals is a major drawback. CAG report, too, indicates it. The State Health Society of Bihar had outsourced the basic life support ambulance services to an agency in 2011. A dispute arose and after Patna high court's intervention in 2014, the SHSB was asked to settle the dues and the agency was asked to return ambulances. "However, as of August 2015, neither payment was made by the SHSB nor ambulances were returned by the agency," the CAG report says.

Experts say the declining rate of institutional delivery could have multiple effects, the most important being maternal mortality rate (MMR). If a woman does not stay in a hospital for 48 hours after delivery, there are chances she might not be able to cope with complications, primarily heavy bleeding post delivery, and may even die. It is one of the major reasons for maternal mortality.

Another critical indicator which might suffer a decline due to falling institutional delivery rate is initiation of breastfeeding within one hour of birth which is usually assisted by a nurese. The initiation of breastfeeding takes place only in 34.9 per cent cases in Bihar presently . This is critical because the first milk, given within half-an-hour of birth, is highly rich in protein that develops immunity in child. If breastfeeding is not initiated on time, breast engorment takes place due to collection of milk in the breasts, which can be harmful for the woman.

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